Adjunctive 3D-ICE during transcatheter tricuspid valve replacement was associated with longer procedures but similar 30-day mortality compared to TEE alone (3.4% vs 5.6%, p=0.65).
Cohort (n=100)
No
Does adjunctive 3D-ICE compared to TEE alone affect procedural duration, residual TR, and clinical outcomes in patients undergoing TTVR?
Adjunctive 3D-ICE during TTVR is feasible for complex cases with suboptimal TEE, yielding similar short-term clinical outcomes despite longer procedural times and higher baseline complexity.
Absolute Event Rate: 3.4% vs 5.6%
p-value: p=0.65
Abstract Aims Transcatheter tricuspid valve replacement (TTVR) is a novel treatment for patients with severe tricuspid regurgitation (TR). Procedural success hinges on intraprocedural imaging quality. Three-dimensional intracardiac echocardiography (3D-ICE) is an important adjunctive imaging modality in this setting; however, data on optimal use strategies remain limited. Methods and results Retrospective review of 100 patients undergoing TTVR at a single center between February 2024 and April 2025 was conducted. 3D-ICE was employed selectively as adjunctive imaging when transesophageal echocardiography (TEE) was suboptimal. Baseline characteristics and procedural outcomes were analyzed. 3D-ICE was used in 29 patients. Baseline characteristics were similar between groups, although patients requiring ICE had higher prevalence of cardiovascular implanted electronic devices (CIED) (52% vs 24%, p0.05). Procedural duration was longer in 3D-ICE patients, (141 IQR 123, 180 minutes) compared to TEE-alone, (115 100, 138 minutes, p0.05), although this improved over time. Post-procedurally, patients requiring adjunctive 3D-ICE had more residual TR (mild in 14% vs 3%, p0.05). There was no difference in 30-day mortality (3.4% ICE vs 5.6%, p=0.65) or Kansas City Cardiomyopathy-Questionnaire scores at follow-up (65% ICE vs 51%, p=0.24). Conclusion This is the first large-scale report of 3D-ICE use during TTVR with EVOQUE. 3D-ICE was employed when TEE was suboptimal, often in patients with CIEDs. Its use correlated with longer procedures and more residual TR, likely reflecting higher case complexity, though clinical outcomes were equal. Procedural efficiency improved over time, with no cases aborted due to imaging. Primary 3D-ICE approach may have similar procedural time without affecting safety, supporting further evaluation of upfront ICE use and focused training.
Fram et al. (Thu,) conducted a cohort in Severe tricuspid regurgitation (n=100). 3D-ICE (Three-dimensional intracardiac echocardiography) vs. TEE-alone (transesophageal echocardiography) was evaluated on 30-day mortality (p=0.65). Adjunctive 3D-ICE during transcatheter tricuspid valve replacement was associated with longer procedures but similar 30-day mortality compared to TEE alone (3.4% vs 5.6%, p=0.65).